Not It.

Last Thursday, Tab fell at camp and one of his legs looked rough enough that his camp took him to the ER for X-rays. Dx: hematoma. Rx: Motrin, ice, rest.

ouch

I’m trying to show the bigness of the hurt leg.

Two days later, camp ended and Tab came home, and we left for vacation on a tiny island. That was Sunday. His leg still hurt, kind of. On Monday (four days post-injury), the hematoma had become inflamed, and his BG was over 400 mg/dL. That had never happened before. Tab was mad thirsty, his head hurt, and his eyes hurt. And his leg hurt. No ketones. I was much more concerned about the BG than the L-E-G.

nh

Note to self: BYO ketone strips, duh.

For whatever dumb reasons (ho-diddly-hum, if Bubs has ketones all we do is give insulin to treat the high anyway and I’m sure I’ll remember to get this insignificant prescription filled before we leave for the tiny island), I’d not packed ketone strips for our trip. This meant I had to get one from the island infirmary, which opened a whole can of worms. (My son was just diagnosed with Type 1 diabetes, his blood glucose is over 400, and I forgot to pack ketone strips is not the beginning of a story that inspires confidence.)

The island doctor examined the inflamed hematoma. Dx cellulitis. Rx antibiotics. The island nurse outlined the hematoma in Sharpie, so we would be able to see it grow or shrink. I can’t blame the doctor/nurse for wanting to tell me information about diabetes, since I was apparently enough of a newb that I needed help testing for ketones. There was an uncomfortable (for me) amount of information sharing regarding—you can imagine—diabetic people not being able to heal, diabetic people need special soap made by Clorox, diabetic people can get insulin through a pump that automatically corrects their blood glucose. And then, on the other hand, information was shared also about how Tab must not have T1d if he doesn’t take insulin, he must have T2, the A1c has to be over six to be diagnosed with diabetes, I must have misunderstood. Thank you.

The chip on my shoulder grew to ten times its normal size.

A new doctor from dream endo’s office evaluated BG data over the phone and determined the high BG was due to the infection (and not the inverse), Tab’s BG would return to baseline (i.e. kinda high but not so high) without insulin, and the island doctor should treat the infection as a normal-people infection, not a diabetes thing.

ebola

I wondered if the high BG was fueling the infection. Don’t bacteria hulk out on sugar? I also wondered if the fever might be due to an unrelated but concurrent viral infection that was kicking his T1d from the TrialNet kind and into the go-to-the-hospital kind. Meanwhile, he wondered if he might have Ebola.

On Wednesday (six days post-injury now), Tab woke up with a fever and felt quite ill. The island doctor determined the leg was not responding to the antibiotics and sent him off-island to the emergency room for IV antibiotics. The ER doctor said the leg was not infected, just swollen, no antibiotics were needed, and to come back the next day for a re-check. Hrrrrm.

Instead of hanging around a random hospital in New Hampshire, Tab and Joe opted to go home. That way, if an IV antibiotic (or, I was still thinking, some kind of diabetes jamboree) would ensue, that could all happen in our usual hospital.

On Thursday morning (one week post-injury), Tab and Joe went to our pediatrician’s office. She said the leg was indeed infected, but wondered why the island doctor had prescribed an antibiotic used almost exclusively for Lyme disease. She prescribed a different oral antibiotic. It is a beautiful shade of turquoise and is, apparently, magic.

to here

Two days later, it is shriveling up, begging for mercy. As evidenced by dotted Sharpie line, barely visible.

On Friday, Bubs and I came home from the tiny island. Today, I took Tab to the pediatrician for a re-re-re-check. His leg looks better and he feels better. Good.

BUT THESE MYSTERIES REMAIN:

  1. Did the d-bomb sway which antibiotic the island doctor prescribed? Because why else did he choose something the pediatrician thought was weird? Or is the pediatrician weird? Or is no one weird, but just different?
  2. Does high BG make an infection worse? Can high BG cause an infection where none would be, otherwise?
  3. Why did the ER doctor think there was no infection? (Was it because she didn’t see the DM written under “past medical history” on the note from the island doctor?) Would a person consider infection in a hematoma if D were not a factor? Was D a factor in this hematoma?

I guess none of this matters. Tab’s getting better. He feels better. His leg looks better and hurts less. We still need an endocrinologist. The endo on call was nice. Maybe she will be the one.

 

 

 

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